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Posts for category: Oral Health

By Dr. Terry Fayad
October 12, 2021
Category: Oral Health
Tags: osteoporosis  
OsteoporosisCanCauseComplicationsForSomeTypesofDentalWork

October 20th is World Osteoporosis Day, putting the spotlight on this degenerative bone condition and the impact it has on millions of people. Not only does it significantly increase the risk of potentially life-threatening fractures, but it can also indirectly affect dental health.

This connection arises from the use of certain treatment drugs that ultimately could lead to complications following some forms of dental work. These particular drugs, mainly bisphosphonates like Fosamax™ and RANKL inhibitors like Prolia™, destroy bone cells called osteoclasts, whose function is to clear away worn out regular bone cells (osteoblasts). With fewer osteoclasts targeting them, more older osteoblast cells survive longer.

In the short-term, a longer life for these older cells helps bones afflicted by osteoporosis to retain volume and density, and are thus less likely to fracture. Long-term, however, the surviving osteoblasts are less elastic and more brittle than newly formed cells.

In the end, these longer living cells could eventually weaken the bone. In rare situations, this can result in parts of the bone actually dying—a condition known as osteonecrosis. The bones of the body with the highest occurrences of osteonecrosis are the femur (the upper leg bone) and, of specific concern to dental care, the jawbone.

The effect of these medications on the jawbone actually has a name—drug-induced osteonecrosis of the jaw (DIONJ). Fortunately, there's only a 1% risk of it occurring if you're taking these drugs to manage osteoporosis. It's also not a concern for routine procedures like cleanings, fillings or crown placements. But DIONJ could lead to complications with more invasive dental work like tooth extraction, implant placement or periodontal surgery.

It's important, then, that your dentist knows if you're being treated for osteoporosis and the specific drugs you're taking. Depending on the medication, they may suggest, in coordination with your physician, that you take a "drug holiday"—go off of the drug for a set period of time—before a scheduled dental procedure to ease the risk and effects of osteonecrosis.

Because infection after dental work is one possible consequence of osteonecrosis, it's important that you practice thorough oral hygiene every day. Your dentist may also prescribe an antiseptic mouth rinse to include with your hygiene, as well as antibiotics.

You may also want to talk to your doctor about alternative treatments for osteoporosis that pose a lower risk for osteonecrosis. These can range from traditional Vitamin D and calcium supplements to emerging treatments that utilize hormones.

Osteoporosis can complicate dental work, but it doesn't have to prevent you from getting the procedures you need. Working with both your dentist and your physician, you can have the procedures you need to maintain your dental health.

If you would like more information about osteoporosis and dental care, please contact us or schedule a consultation.

By Dr. Terry Fayad
September 12, 2021
Category: Oral Health
Tags: tooth decay  
HowtoPreventToothDecayinYourSpecialNeedsChild

Preventing tooth decay from developing in your child's teeth requires a strong commitment to daily oral hygiene. But if you have a child with a chronic physical or behavioral condition, you might find it difficult to keep that commitment in the light of other pressing health needs.

But tooth decay is just as important a health issue as the others with which you may contend. Because primary teeth guide incoming permanent teeth to erupt properly, losing them prematurely can lead to a poor bite and other associated problems. This could further diminish their quality of life already compromised by their chronic condition.

Helping your special needs child avoid tooth decay isn't easy—but it can be done. Here's how!

Brush and floss for them. Normally, a parent's goal is to help their children learn to care for their teeth on their own. But depending on the nature of your child's chronic disease, that may not be possible. Instead, you may need to take an active role in their daily hygiene for the foreseeable future, even brushing and flossing for them if necessary.

Model proper dental care. Even so, it's still a good idea to guide them toward performing oral hygiene tasks without assistance, according to their abilities. This could be a long road, though, one that requires your active participation. You can ease this process by continuously modeling good dental care behavior for them through brushing and flossing together.

See an understanding dentist. Although caring for a special needs child can be isolating, you don't have to go at it alone. That includes taking care of their teeth and gums: A dentist who has both training and experience in treating children with chronic health conditions can become an important partner in your efforts to fight tooth decay.

Communicate between all care providers. Likewise, having everyone involved in your child's care on the same page can make decay prevention a much easier process. Be sure then to share your concerns about your child's needs, including dental care, with attending physicians, therapists and, of course, dentists.

If you would like more information on dental care for special needs children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Managing Tooth Decay in Children With Chronic Diseases.”

HeresWhatsinYourToothpasteforKeepingYourTeethandGumsHealthy

We're all interested in how our toothpaste tastes, how it freshens breath or how it brightens teeth. But those are secondary to its most important function, which is how well our toothpaste helps us remove dental plaque, that thin bacterial film on teeth most responsible for both tooth decay and gum disease.

Daily brushing and flossing clear away dental plaque, resulting in a much lower risk for dental disease. But while the mechanical action of brushing loosens plaque, toothpaste helps complete its removal. It can do this because of two basic ingredients found in nearly every brand of toothpaste.

The first is an abrasive (or polishing agent), a gritty substance that boosts the effectiveness of the brushing action (which, by the way, alleviates the need for harmful aggressive brushing). These substances, usually hydrated silica, hydrated alumina or calcium carbonate, are abrasive enough to loosen plaque, but not enough to damage tooth enamel.

The other ingredient, a detergent, works much the same way as the product you use to wash greasy dishes—it breaks down the parts of plaque that water can't dissolve. The most common, sodium lauryl sulfate, a safe detergent found in other hygiene products, loosens and dissolves plaque so that it can be easily rinsed away.

You'll also find other ingredients to some degree in toothpaste: flavorings, of course, that go a long way toward making the brushing experience more pleasant; humectants to help toothpaste retain moisture; and binders to hold bind all the ingredients together. And many toothpastes also contain fluoride, a naturally-occurring chemical that strengthens tooth enamel.

You may also find additional ingredients in toothpastes that specialize in certain functions like reducing tartar buildup (hardened plaque), easing tooth or gum sensitivity or controlling bacterial growth. Many toothpastes also include whiteners to promote a brighter smile. Your dentist can advise you on what to look for in a toothpaste to meet a specific need.

But your first priority should always be how well your toothpaste helps you keep your teeth and gums healthy. Knowing what's in it can help you choose your toothpaste more wisely.

If you would like more information on oral hygiene products and aids, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Toothpaste: What's in It?

PeriodontalProbingCanTellUsaLotAbouttheSeverityofaGumInfection

The red and puffy gums that sometimes accompany the onset of periodontal (gum) disease don't always catch your attention. You may not even get any symptoms at all, in fact, until the disease has become well advanced.

That's why regular dental visits are so important for gum health: For while you may not notice anything abnormal about your gums, we have a simple procedure known as periodontal probing that can help diagnose the condition of your gums.

Gum disease is a common bacterial infection that affects millions of people worldwide. It most often begins with plaque, a filmy, bacterial buildup on teeth. These bacteria feed and multiply on the remnant food particles in the film, increasing the chances for an infection.

As it grows—as well as the inflammation the body initiates to fight it—the infection weakens the gum attachment to teeth. This can cause the miniscule gap between gums and teeth at the gum line to widen, forming a void called a periodontal pocket. The deeper and wider the pocket, the more advanced the gum infection.

We may be able to verify the presence of a periodontal pocket by using a long, thin probing instrument with millimeter gradations. We gently insert the probe at various locations around a tooth as far as it will comfortably go. We then record the depth by reading the gradation measures lined up with the top of the gums, as well as observing how snug or loose the probe feels within the gum space.

One to three millimeters signifies a healthy attachment between the tooth and gums—anything more than that usually indicates gum disease. Measurements of 5mm indicates a problem, the higher the number, the more advanced is the periodontal disease.

We use these probe readings and other factors to guide our treatment approach in individual cases of gum disease. With a less-advanced infection we may only need to remove plaque and calculus adhering to the crown and just below the gum line. More advanced gum disease infecting the root area may require surgical access through the gums.

All in all, keeping up with regular dental visits can increase the chances of early diagnosis, when the disease is still in its initial stages. And daily oral hygiene to remove harmful plaque may help you avoid gum disease altogether.

If you would like more information on treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Understanding Periodontal Pockets.”

4WaysYourChildsDentalHealthCanGetOfftoaGoodStartThisNewSchoolYear

If your kids are getting ready to start back with in-person school this year, you've no doubt began stocking up on new clothes and classroom supplies. Right before school begins is also a good time to make sure their teeth and gums are in good shape.

Life gets busier for families once the school year begins. It's wise, then, to take advantage of the waning summer break's slower pace to catch up on other concerns, including teeth and gum health. In that regard, here are 4 aspects of dental care deserving attention before the school bell rings in a new year.

Cleanings. Hopefully, your kids are brushing and flossing every day, a habit they've practiced from an early age. But while these hygiene tasks effectively rid the teeth of most of the accumulated dental plaque (the thin bacterial film most responsible for tooth decay), some of it can slip by. A thorough dental cleaning every six months can clear away elusive plaque and tartar (hardened plaque)—and right before the school year begins is a great time.

Checkups. Regular dental visits also make it easier to stay ahead of any developing tooth decay or other dental disease. We have advanced equipment and methods for detecting even the tiniest occurrence of disease—and the earlier we find and treat it, the less damage it can cause. We can also perform preventive procedures like sealants or topical fluoride that reduce the risk of tooth decay.

Bite evaluation. It's also a good idea for a child just starting school (around age 6) to undergo a bite evaluation with an orthodontist. These dental specialists are trained and experienced in detecting jaw and tooth development that's not proceeding on a normal track. It's possible that finding and treating a bite problem early on could help you avoid orthodontic treatment in the future.

Sports protection. In addition to school, many older kids are also preparing for a new sports season, particularly football and basketball. But kids in these and other hard contact sports are also at risk for injury, particularly to the mouth from a hard impact. You can lessen that risk by obtaining an athletic mouthguard for them that cushions any blows to the face and jaw. The best option is a custom mouthguard we create for your child based on their individual dental dimensions.

It takes a lot of time and effort to ensure your child's school year gets off to a good start. Be sure that includes looking after their dental health.

If you would like more information about children's dental care, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Athletic Mouthguards.”